By Bethany Edwards, Ph.D.
Antisocial personality disorder (ASPD) and psychopathy are two constructs commonly discussed in relation to individuals in the justice system. While both are relevant to this population, ASPD and psychopathy are often confused with each other and despite sharing characteristics, they differ in important ways (Edwards et al., 2019; Hare, 1996; Ogloff, 2006). Per the Diagnostic and Statistical Manual, Fifth Edition, Text Revision (DSM-5-TR), ASPD is a personality disorder reflecting a longstanding and consistent pattern of disregard for others and their rights. A diagnosis of ASPD is provided for an individual age 18 or older when there is evidence of conduct problems (e.g., aggressiveness, destruction of property, deceitfulness/theft, serious rule violations) prior to age 15, along with at least three symptoms of ASPD (i.e., unlawful behavior, deceitfulness, impulsivity, irritability and aggressiveness, reckless disregard for others, irresponsibility, lack of remorse) since age 15. Whereas psychopathy is not formally recognized as a personality disorder in the DSM-5-TR, it has received notable empirical attention such that recently, research on it has surpassed that on ASPD (Hare & Neumann, 2008; Ogloff, 2006). Confusion between ASPD and psychopathy stems from the two including many of the same behavioral characteristics. However, in addition to many shared behavioral characteristics with ASPD, psychopathy encompasses core interpersonal and affective traits; specifically, superficial charm, grandiosity or inflated sense of self-worth, shallow affect, lack of empathy, and failure to accept responsibility (Hare, 2003). Psychopathic traits are often assessed using the Psychopathy Checklist-Revised (PCL-R) via a semi-structured interview and review of collateral information (Hare, 2003).
Given behavioral characteristics comprising both ASPD and psychopathy, it is not surprising that rates of ASPD and psychopathy are higher in criminal justice populations than in the general population. Reasons for this pull from the fact that both ASPD and psychopathy explicitly include criminality, as well as behaviors that overlap with other difficulties (e.g., impulsivity, risky and aggressive behavior, irresponsibility) prevalent in the justice system (e.g., substance use problems, trauma exposure) (Cunningham & Reidy, 1998; Glenn et al., 2013). However, ASPD is far more prevalent than psychopathy. For example, research has estimated offender rates for ASPD between 50% and 80% and per the DSM-5-TR, ASPD is highest among men with histories of substance use or in forensic/prison settings, with rates above 70% (Ogloff, 2006). As a result, ASPD has been criticized for an overreliance on antisocial behavior that likely leads to inflated rates in the justice system (Edwards et al., 2019; Ogloff, 2006). In contrast, psychopathy encompasses more and a wider variety of traits and thus, prevalence rates are much lower, such that only 15-25% of incarcerated men are thought to show high levels of psychopathic traits (Hare, 2003). Given this, psychopathy has been regarded as more useful than ASPD in predicting problematic outcomes (e.g., violence, criminal recidivism) and identifying individuals at elevated risk for them (Kiehl & Hoffman, 2011). As a result, researchers continue to explore ways in which the assessment of psychopathic traits, in particular, may aid in risk prediction within the criminal justice system.
References
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